使用面罩行心肺运动试验（CPET）可能导致误诊的临床观察研究*

doi:10.12047/j.cjap.0101.2021.127

中国应用生理学杂志 ›› 2021, Vol. 37 ›› Issue (2): 219-224.doi: 10.12047/j.cjap.0101.2021.127

• 研究论文 • 上一篇

使用面罩行心肺运动试验（CPET）可能导致误诊的临床观察研究^*

马铭欣^1,2, 孙兴国^1△, 邹昱馨^1,4, 杨巧芝⁴, 黄燕^1,2,3△, 陈荣^1,2, 台文琦¹, 王继楠¹, 周晴晴¹, 刘方¹, 石超¹, 徐凡¹, 张也¹, 李浩¹, 冯云红^1,5, 王冬^1,5

1.中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室国家心血管疾病临床医学研究中心,北京 100037;
2.辽宁省大连儿童医院,大连116000;
3.中国科学院大学医学院,北京 100037;
4.山东省聊城市立医院儿童医院,聊城252000;
5.江苏省如皋市人民医院,如皋 226500

收稿日期:2020-08-12 修回日期:2021-03-10 出版日期:2021-03-28 发布日期:2021-10-20
通讯作者: ^△Tel：010-88398300;E-mail: xgsun@lundquist.org
基金资助:
^*国家高技术研究发展计划（863计划）课题资助项目（2012AA021009）; 国家自然科学基金医学科学部面上项目（81470204）; 中国康复医疗机构联合重大项目基金（20160102）; 中国医学科学院国家心血管病中心阜外医院科研开发启动基金（2012-YJR02）; 首都临床特色应用研究与成果推广（Z161100000516127）; 北京康复医院2019-2021科技发展专项（2019-003）; 北京协和医学院教学改革项目（2018E-JG07）; 北京协和医学院-国家外国专家局外国专家项目（2015,2016,T2017025,T2018046,G2019001660）; 重庆市卫计委医学科研计划项目（2017MSXM090）; 重庆市科委社会事业与民生保障科技创新专项项目（cstc2017shmsA130063）

The preliminary report of investigation: Using mask for cardiopulmonary exercise testing in Chinese children may result misinterpretation and misdiagnosis

MA Ming-xing^1,2, SUN Xing-guo^1△, ZOU Yu-xin^1,4, YANG Qiao-zhi⁴, HUANG Yan^1,2,3△, CHEN Rong^1,2, TAI Wen-qi¹, WANG Ji-nan¹, ZHOU Qing-qing¹, LIU Fang¹, SHI Chao¹, XU Fan¹, ZHANG Ye¹, LI Hao¹, FENG Yun-hong^1,5, WANG Dong^1,5

1. Fuwai Hospital, Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/ State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100037;
2. Dalian Children's Hospital of Liaoning Province, Dalian 116000;
3. Chinese Academy of Sciences University School of Medicine, Beijing 100037;
4. Children's Hospital of Liaocheng Municipal Hospital of Shandong Province, Liaocheng 252000;
5. The People's Hospital of Rugao City, Rugao 226500, China

Received:2020-08-12 Revised:2021-03-10 Online:2021-03-28 Published:2021-10-20

摘要/Abstract

摘要： 目的: 观察面罩增加解剖死腔,归纳总结CPET新9图结果中运动诱导的波浪式呼吸（EIOB）产生的规律,并分析出其发生率及易产生波浪式呼吸的年龄段。方法: 本研究全部CPET实验数据结果来自2014年至今在聊城市儿童医院门诊完成CPET的3至14岁的501例儿童。通过严格质控,根据Harbor-UCLA标准操作流程在经过特殊座位处理的儿童精准功率计上完成症状限制极限运动的CPET,通过CPET数据的标准化计算分析判读,对不同年龄儿童的气体交换特征性表现的EIOB发生频率进行分析,同时分析高强度运动时漏气导致摄氧量和氧脉搏递增变缓的可能。结果: 3~6 岁组EIOB 的发生率最高, 为42%;7~10 岁组EIOB 的发生率为29.4%,11~14 岁组EIOB 的发生率为29.9%。三组经卡方检验（x²=7.512）,差别具有统计学意义（P<0.05）。508 例患儿中有14 例在CPET 过程中出现漏气情况,发生率为2.7%。结论: 儿童出现波浪式呼吸（OB）现象可能因为面罩增加了解剖死腔,并非疾病所致。为提高CPET质控和减少临床误诊建议尽可能使用较少增加死腔的咬口器。

关键词: 心肺运动试验, 死腔, 使用面罩, 运动波浪式呼吸, 错误诊断, 临床医学

Abstract: Objective: Observe the increased anatomical dead space of the mask, summarize the law of exercise induced oscillatory breathing (EIOB) in the results of CPET's new 9 figure, and analyze its incidence and age groups that are prone to oscillatory breathing. Methods: After signed the informed consent form by guardian, 501 children from pre-school to middle-school, aged 3~14 year, performed Harbor-UCLA standard protocol CPET with strict quality control in the CPET laboratory of Liaocheng Children's Hospital since 2014. CPET data was interpreted second by second from the breath by breath collection, averaged by 10s and then display by 9 plots. We analyzed the trends, pattern, incidence and age difference for EIOB and gas leakage. Results: The incidence of EIOB was the highest in the 3 to 6-year-old group, which was 42%. The 7 to 10-year-old group was 29.4% and the 11- to 14-year-old group was 29.9%. The three groups were tested by chi-square (x²=7.512), and the difference was statistically significant (P<0.05). 14 out of 508 children had air leakage during CPET, the incidence rate was 2.7%. Conclusion: The phenomenon of oscillatory breathing (OB) in children may be caused by the increased anatomical dead space of the mask, and it is not caused by disease. To improve the quality of CPET and to reduce clinical misdiagnosis, it is recommended to use a mouthpiece to decrease the dead space rather than the musk.

Key words: cardiopulmonary exercise testing, dead space, using mask, exercise induced oscillatory breathing, misdiagnosis, clinical medicine

中图分类号:

马铭欣, 孙兴国, 邹昱馨, 杨巧芝, 黄燕, 陈荣, 台文琦, 王继楠, 周晴晴, 刘方, 石超, 徐凡, 张也, 李浩, 冯云红, 王冬. 使用面罩行心肺运动试验（CPET）可能导致误诊的临床观察研究^*[J]. 中国应用生理学杂志, 2021, 37(2): 219-224.

MA Ming-xing, SUN Xing-guo, ZOU Yu-xin, YANG Qiao-zhi, HUANG Yan, CHEN Rong, TAI Wen-qi, WANG Ji-nan, ZHOU Qing-qing, LIU Fang, SHI Chao, XU Fan, ZHANG Ye, LI Hao, FENG Yun-hong, WANG Dong. The preliminary report of investigation: Using mask for cardiopulmonary exercise testing in Chinese children may result misinterpretation and misdiagnosis[J]. CJAP, 2021, 37(2): 219-224.

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使用面罩行心肺运动试验（CPET）可能导致误诊的临床观察研究^*

The preliminary report of investigation: Using mask for cardiopulmonary exercise testing in Chinese children may result misinterpretation and misdiagnosis

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